Adjacent Muscle Research Articles

African Wild Dogs (Lycaon pictus) Show Adaptations to Sociality and Hypercarnivory in Their Cranial Musculature

African wild dogs (Lycaon pictus) are highly social canids that live in large, hierarchical packs and engage in coordinated hunts. Recent research has suggested that enlarged muscles associated with expressive movement of the eyes and eyebrows may have evolved in domestic dogs (Canis familiaris) to facilitate interspecies communication with their human owners. In L. pictus, communication is reported to occur predominantly through vocalization with reduced reliance on facial expressions; however, the mimic muscles in L. pictus have never been described and evaluated. L. pictus is also hypercarnivorous with the highest documented bite force quotient of any mammalian carnivore. It has large, mobile ears, which enhance its auditory capabilities while hunting and assist with thermoregulation.We performed detailed dissections of the muscles of facial expression, mastication, and auricular movement in an adult male L. pictus,and conducted diffusible iodine‐based contrast‐enhanced computed tomographic (diceCT) scans of the head. Musculus levator anguli oculi medialis (LAOM) and retractor anguli oculi lateralis (RAOL), muscles of hypothesized importance in domestic dog‐human non‐verbal communication, are enlarged in L. pictus, suggesting that ocular expressions represent a significant component of communication. LAOM exhibits an intricate relationship with adjacent orbital musculature including partial fusion along its borders with mm. orbicularis oculi and frontalis. Muscles that draw the angles of the mouth caudally (e.g., m. zygomaticus major) are expanded. Numerous ramifying branches of CN VII and CN V2 course across the face to provide extensive sensory and motor innervation. These findings indicate that facial expression musculature of African wild dogs is well‐equipped for non‐verbal communication and that the same adaptations argued to facilitate communication between domestic dogs and humans may also facilitate intraspecific communication in L. pictus.Muscles of mastication are especially enlarged in L. pictus, with multiple bellies of mm. masseter and temporalis separated by deep layers of thick intermuscular fascia and with expanded insertions onto the mandible. Musculus digastricus is composed of a single, large belly without intervening tendon, and it receives its innervation exclusively from CN V3. These enlargements reflect increased masticatory capabilities in L. pictus, which enable its powerful bite force and hypercarnivorous diet. Auricular muscles are also well‐developed, supporting greater leverage and fine manipulation of its large, mobile ears. Musculus frontoscutularis is well‐developed and distinctly separable from m. frontalis, suggesting greater leverage of the auricle via attachments to the scutiform cartilage. The intrinsic ear muscles differ in pattern and orientation from all other published canids, demonstrating unique muscular control over rotation and fine manipulation of the auricle. Taken together, these morphological patterns illustrate that specific adaptations in the cranial musculature of L. pictus facilitate its ecological habits.

A Qualitative Comparison of Manual and K‐means Segmentation for Whole‐slide Histology Images of Rabbit Vocal Folds

IntroductionSurgical treatment for subglottic stenosis often faces recurrence of narrowing and patients continue to face quality of life issues. Currently, biomechanical models that inform surgical treatments are difficult to create due to vocal fold intricacies and trouble distinguishing between tissue types–muscle, mucosa, and cartilage. Improved models of laryngeal microanatomy can be used to assess and predict surgical outcomes for patients who suffer from subglottic stenosis. While manual segmentation of histology is the standard, automatic segmentation can be more efficient, sensitive, and specific in tissue differentiation. Manual segmentation faces challenges like extensive operator time and inter‐rater subjectivity. The aim of this study, therefore, was to qualitatively compare manual segmentation to automatic k‐means segmentation of whole‐slide histology rabbit vocal fold images. This is the preliminary step towards enhancing segmentation and, later, achieving a high‐fidelity human larynx model.Methods134 whole‐slide histology images were manually segmented from seven rabbits using colored masks for muscle, cartilage, mucosa, and adipose tissue. Of those images, 31 were also selected for segmentation using k‐means for initial qualitative comparison. At least two images were segmented per rabbit. K‐means segmentation is optimal for our multidimensional data. Since it is deterministic, we selected the number of clusters as our parameter. After inspecting n=1‐10 clusters, n=4 was chosen as qualitatively producing the most distinct clusters without oversampling.ResultsFor our preliminary results, we compared the histological image, the manual segmentation, and the automatically segmented image. In the automatic segmentations, tissue type is distinguished by the grayscale contrast. The four classes visible are cartilage, muscle, adipose tissue, and mucosa. There is occasional loss of visualization of adipose tissue and mucosa, however, the cartilage and muscle tissues remain distinct. The mucosal area boundaries remain clear despite some visualization loss within the mucosal borders, therefore, mucosa can be distinguished from adjacent cartilage and muscle. Training on a large dataset like other machine learning algorithms is unnecessary for k‐means, which is ideal for our relatively small sample size. The speed and versatility of k‐means has qualitatively demonstrated comparable results to our manual segmentations.ConclusionFuture directions for our project include conducting k‐means segmentation of the remainder of the 134 images collected. We have also tested mean‐shift clustering and a deep learning convolutional neural network (CNN) to compare automatic segmentation methods to one another, and to the standard manual segmentation/ground truth. Future testing also includes quantitative analysis of these algorithms’ accuracy. Beyond our histology images, we have at least 14 MR images (at least two per rabbit) of the larynges as well. We intend to combine and overlay the structural detail of the histology images with the soft tissue differentiation of the MRI.

Clinicopathologic and imaging features of a primary poorly differentiated extradural haemangiosarcoma with polyostotic vertebral involvement and pulmonary metastases in a dog

AbstractAn 8‐year‐old, Staffordshire bull terrier was referred for a progressive 8‐week history of left pelvic limb paresis, postural reaction deficits, perineal hypoalgesia and lumbosacral pain. Magnetic resonance imaging revealed a L5–Cd1 circumferential T1‐weighted isointense, T2‐weighted/short Tau inversion recovery hyperintense extradural mass, causing severe spinal cord compression with multifocal lesions of L5–L7 vertebral bodies and extension to paraspinal musculature. Unlike previous reports, both vertebral and epidural lesions showed heterogeneous contrast enhancement, while adjacent paraspinal musculature showed mild ill‐defined enhancement. Computed tomography revealed pulmonary metastases and excluded primary lesion elsewhere. An epidural neoplasm with polyostotic vertebral involvement and pulmonary metastases was suspected. Dorsal laminectomy allowed for decompression and excisional biopsy confirming a diagnosis of poorly differentiated haemangiosarcoma. Haemangiosarcoma should be considered as a differential for primary extradural spinal neoplasia.

Semiautomated Segmentation and Volume Measurements of Cervical Carotid High-Signal Plaques Using 3D Turbo Spin-Echo T1-Weighted Black-Blood Vessel Wall Imaging: A Preliminary Study.

Unstable carotid plaques are visualized as high-signal plaques (HSPs) on 3D turbo spin-echo T1-weighted black-blood vessel wall imaging (3D TSE T1-BB VWI). The purpose of this study was to compare manual segmentation and semiautomated segmentation for the quantification of carotid HSPs using 3D TSE T1-BB VWI. Twenty cervical carotid plaque lesions in 19 patients with a plaque contrast ratio of > 1.3 compared to adjacent muscle were studied. Using the mean voxel value for the adjacent muscle multiplied by 1.3 as a threshold value, the semiautomated software exclusively segmented and measured the HSP volume. Manual and semiautomated HSP volumes were well correlated (r = 0.965). Regarding reproducibility, the inter-rater ICC was 0.959 (bias: 24.63, 95% limit of agreement: −96.07, 146.35) for the manual method and 0.998 (bias: 15.2, 95% limit of agreement: −17.83, 48.23) for the semiautomated method, indicating improved reproducibility by the semiautomated method compared to the manual method. The time required for semiautomated segmentation was significantly shorter than that of manual segmentation times (81.7 ± 7.8 s versus 189.5 ± 49.6 s; p < 0.01). The results obtained in this study demonstrate that the semiautomated segmentation method allows for reliable assessment of the HSP volume in patients with carotid plaque lesions, with reduced time and effort for the analysis.

A case of B Cell Lymphoma, NOS – A Manifestation in the Labial Mucosa

<h3>Introduction</h3> Non-Hodgkin's lymphoma of B cell lineage is the third most common malignancy of the maxillofacial region. DLBCL, NOS constitutes 25% - 35% of the adult non-Hodgkin's lymphomas and is more common in elderly individuals, as well as more prevalent in males than in females. The etiology of DLBCL, NOS remains unknown. Underlying immunodeficiency is a significant risk factor. <h3>Materials and Methods</h3> We report a case of a 78-year old female patient who presented with a lump in the upper labial mucosa since two weeks, there were no symptoms prior to the stated time duration. The soft tissue mass was located approximately 4mm from the vermillion border, adjacent to the incisal edges of teeth #10 and 11 (left maxillary lateral incisor and canine), measured around 1cm in diameter and was firm on palpation. The clinical differential included benign salivary gland neoplasms, lipoma and a mucocele. The patient had a past medical history of diffuse large B cell lymphoma three years ago. <h3>Results</h3> Microscopic examination showed an atypical lymphoid proliferation involving the soft tissue with infiltration into the adjacent skeletal muscles. A few residual ductular/glandular elements were also noted. The biopsy was composed of a monotonous infiltrate of medium sized cells with round to irregular nuclei, one or more prominent nucleoli and scant cytoplasm. A polymorphous inflammatory background was not observed, and the cells diffusely infiltrated in to the soft tissue. Immunohistochemistry revealed that the atypical cells were positive for CD20 and BCL2 while negative for CD10, BCL6 and c-Myc. Ki-67 proliferation index was moderate to high. <h3>Conclusions</h3> In summary, the overall features were consistent with a B-cell lymphoma that was difficult to further classify due to limited sampling. Based on the relatively high proliferative rate, the lesion was likely consistent with recurrence of the previously diagnosed diffuse large B-cell lymphoma.

Pilot feasibility study of a simple regenerative peripheral nerve interface designed to diminish cutaneous dysesthesia after supraclavicular operations

Supraclavicular operations can be associated with postoperative cutaneous dysesthesia and hypersensitivity. Regenerative peripheral nerve interfaces, created by attaching the proximal end of a divided peripheral nerve into a viable muscle target, can promote neurite regrowth and neuromuscular connections to help suppress painful nerve hyperactivity. During 40 consecutive operations for neurogenic thoracic outlet syndrome, we demonstrated that division of at least one of the superficial supraclavicular cutaneous sensory nerve branches was necessary in 98% of cases. We subsequently developed a novel regenerative peripheral nerve interface for supraclavicular operations using the adjacent omohyoid muscle and have described the technical steps involved in this procedure.

Injury and Healing Response of Healthy Peripheral Arterial Tissue to Intravascular Lithotripsy: A Prospective Animal Study.

ObjectivesIntravascular lithotripsy (IVL) is a novel clinical technique for the management of severely calcified lesions. However, the biological effects of shock wave on the healthy arterial tissue have not been demonstrated. The preclinical safety study aimed to investigate the vascular response to IVL shock wave compared to plain old balloon angioplasty (POBA) in porcine peripheral arteries.MethodsThe left and right iliofemoral arterial segments of 16 mini-pigs were subjected to IVL and POBA, respectively. The vascular response was evaluated using quantitative vascular angiography (QVA), light microscopy, and scanning electron microscopy (SEM) at 0, 5, and 28 days.ResultsWith the emission of shock wave, adjacent muscle contraction was observed. QVA showed there was no statistically significant difference in percent diameter stenosis and late lumen loss between the two groups. SEM examination showed the endothelial cell layer was intact in both groups at all timepoints. Under light microscopy, no area stenosis was observed. However, IVL shock wave resulted in significantly higher percent area stenosis and intimal area at 28 days. Neointima score showed a trend toward a higher rate in the IVL group, although there was no statistically significant difference at 28 days. There were no statistically significant differences in the scored parameters between groups at all timepoints. However, the parameters of inflammation and neointima showed a trend toward higher scores in the IVL group. After disruption of the internal elastic lamina, the arteries demonstrated significantly neointimal thickening.ConclusionsThe safety and operability of IVL are comparable to POBA. The histological response of healthy arteries to IVL shock wave is mild and sustained. IVL shock wave do not cause serious vascular tissue damage, especially endothelial denudation.

Dietary salt initiates redox signaling between endothelium and vascular smooth muscle through NADPH oxidase 4

Prevention of phenotype switching of vascular smooth muscle cells is an important determinant of normal vascular physiology. Hydrogen peroxide (H2O2) promotes osteogenic differentiation of vascular smooth muscle cells through expression of Runt related transcription factor 2 (Runx2). In this study, an increase in dietary NaCl increased endothelial H2O2 generation through NOX4, a NAD(P)H oxidase. The production of H2O2 was sufficient to increase Runx2, osteopontin and osteocalcin in adjacent vascular smooth muscle cells from control littermate mice but was inhibited in mice lacking endothelial Nox4. A vascular smooth muscle cell culture model confirmed the direct involvement of the activation of protein kinase B (Akt) with inactivation of FoxO1 and FoxO3a observed in the control mice on the high NaCl diet. The present study also showed a reduction of catalase activity in aortas during high NaCl intake. The findings demonstrated an interesting cell-cell communication in the vascular wall that was initiated with H2O2 production by endothelium and was regulated by dietary NaCl intake. A better understanding of how dietary salt intake alters vascular biology may improve treatment of vascular disease that involves activation of Runx2.

Acquired scoliosis of the cervical spine secondary to vertebral neoplasia in an aged pony gelding

SummaryA 20‐year‐old New Forest pony gelding presented for investigation of a firm swelling on the right side of the neck and a variably sized patch of sweating on the right side of the cranial neck. Clinical examination revealed moderate scoliosis with right side convexity centred on the mid‐caudal cervical spine. Initial radiographic examination of the cervical spine showed very subtle heterogeneously increased opacity of the vertebral body of the fifth cervical vertebra (C5). Further investigations were declined by the owner. The pony’s clinical condition deteriorated over the following 6 weeks; at this stage, the pony showed proprioceptive deficits of both fore‐ and hindlimbs (grade 1/5 and 3/5 respectively) and difficulty lowering his head to eat from the ground. Repeat radiographs showed mildly increased opacity of the vertebral body of C5 with a small amount of new bone formation ventrally. Neoplasia of the fifth cervical vertebra was suspected. In view of the clinical deterioration and the likely very poor prognosis, the pony was subjected to euthanasia. Post‐mortem computed tomographic examination showed heterogeneously increased attenuation surrounding small, poorly defined regions of reduced attenuation in the trabecular bone of the vertebral body and right transverse process of C5. There was also moderate, irregular periosteal new bone formation on the fifth and sixth cervical vertebrae with a poorly defined mildly hyperattenuating soft tissue structure adjacent to the right pedicle of C5 and extending into the right side of the vertebral canal, compressing the spinal cord to the left side. Post‐mortem examination revealed tan‐coloured tissue running along the right side of the C5 vertebral body, into the right side of the vertebral canal, compressing the spinal cord to the left side and invading adjacent epaxial muscles. Histopathological examination of this tissue was consistent with an undifferentiated sarcoma. To the authors’ knowledge this is the first report of acquired scoliosis secondary to cervical neoplasia in a horse or pony.

The Whiplash Disease Reconsidered.

The natural course of the whiplash disease is reconsidered in relation to the predominant view of its cause. It is assumed that a whiplash-type trauma is causing an acute tissue injury such as a distortion or sprain in the neck followed by neck pain and headache, which then tends to become a chronic pain condition. We conclude that the whiplash disease typically evolves following a minor trauma without any signs of a tissue injury. It presents with central neuromotor dysfunction, such as electromyography (EMG) hyperactivity and abnormal activation patterns associated with dyscoordination of the involved and adjacent muscle groups. This indicates a central neurological rather than a peripheral traumatic pathology. This view places the cause of the whiplash disease within the central nervous system, and, in concordance with the EMG abnormalities and motor dyscoordination, we suggest the term cervical spinal dyssynergia for this pathology. It provides a new paradigm for further investigations of this disease as well as a window for possible specific neuropharmacological therapy directed towards dysfunctional neuromotor control.

Complex regional pain syndrome patient treated with a below knee amputation, implanting nerves directly into muscle: A case report

Persistent, disabling lower extremity pain, outside the distribution of a single nerve, is termed chronic regional pain syndrome (CRPS), but, in reality, this chronic pain is often due to multiple peripheral nerve injuries. It is the purpose of this report to describe the first application of the "traditional," nerve implantation into muscle, usually used in the treatment of a painful neuroma, as a pre-emptive surgical technique in doing a below knee amputation (BKA). In 2011, a 51-year-old woman developed severe, disabling CRPS, after a series of operations to treat an enchondroma of the left fifth metatarsal. When appropriate peripheral nerve surgeries failed to relieve distal pain, a BKA was elected. The approach to the BKA included implantation of each transected peripheral nerve directly into an adjacent muscle. At 5.0 years after the patient's BKA, the woman reported full use of this extremity, using the prosthesis, and was free of phantom limb and residual limb pain. This anecdotal experience gives insight that long-term relief of lower extremity CRPS can be achieved by a traditional BKA utilizing the approach of implanting each transected nerve into an adjacent muscle.

A Photosealed Cap Prevents Disorganized Axonal Regeneration and Neuroma following Nerve Transection in Rats

Background:Neuroma is a common sequela of traumatic peripheral nerve injury that can result in pain and decreased quality of life for patients. Neuromas result from axonal outgrowth in an attempt to reestablish continuity with the disrupted distal nerve end. Photosealing is a light-activated technique whereby tissues can be securely isolated in a strong and secure manner. This study investigated whether photosealing of autologous vein and crosslinked human amniotic membrane (xHAM) to cap the proximal stump of transected sciatic nerve would prevent disorganized axonal regeneration and neuroma in a rat model.Methods:The right sciatic nerve of Lewis rats (n = 27, 300–350 g) was transected 1 cm proximal to the trifurcation. Animals were randomized to one of three groups (n = 9): no further intervention (Group 1), photosealing with xHAM (Group 2), or photosealing with vein (Group 3). After 60 days, rats were euthanized and their right hindlimbs were re-explored for evidence of disorganized axonal regeneration and/or bulbous neuroma.Results:All untreated control animals were found to have protruding nerve fibers, often invading the adjacent muscle, and 33% of these control animals exhibited a bulbous neuroma. Photosealing with xHAM successfully capped 100% of nerves, with no observable axonal outgrowth. Photosealing with vein prevented axonal outgrowth in eight of nine nerves. No bulbous neuroma was found in any photosealed nerves.Conclusion:Nerve capping with photosealed xHAM or autologous vein can prevent axonal outgrowth in transected nerves, therefore decreasing the likelihood of symptomatic neuroma formation following nerve transection injury or surgical intervention.

Botulinum toxin (Botox)

: Botulinum toxin (Botox) is a neurotoxin produced by the bacterium Clostridium botulinum. There are seven types of Botox (A–G) which bind and cleaves one of several neuronal cellular proteins including SNAP-25, syntaxin or VAMP/synaptobrevin. The net result is the inhibition of the release of acetylcholine (Ach) from the terminal bouton of motor neurons resulting in muscle weakness or paralysis. The duration of action of Botox depends on the time taken for cellular mechanisms to regenerate the cleaved proteins and restore the ability for neuronal Ach release, typically 3–6 months. Botox has several medical indications and is effective in reducing pain and/or muscle activity in chronic migraine, myofascial pain, orofacial movement disorders, neuropathic pain, trigeminal neuralgia (TN) and bruxism. Additionally it can be used to treat sialorrhea and Frey syndrome. The injection technique is very simple and can be performed with or without electromyography depending on the indication. Complications relating to the use of Botox are extremely rare and include allergic reaction and unanticipated weakness/paralysis of adjacent muscles.

Septic arthritis and osteomyelitis of the pubic symphysis – a retrospective study of 26 patients

Introduction: Septic arthritis and osteomyelitis of the pubic symphysis (SAS) are rare conditions with nonspecific symptoms leading to diagnostic delay and treatment. Aim: We draw awareness to this condition elucidating the diagnostic procedures, surgical intervention and antibiotic management. Methods: This entail a retrospective follow-up study of 26 consecutive patients, median age of 71 years (range: 48–89) surgically treated for septic arthritis of the pubic symphysis between 2009 and 2020. Patient files, diagnostic imaging and bacterial cultures were evaluated. Results: Before diagnosed with SAS, 21 of the patients had previous pelvic surgery (16 due to malign conditions, 5 due to benign conditions), while 5 of the patients were not previously operated. Median follow-up period after SAS surgery was 18.5 months (range: 8 to 144.5 months). Dominating symptoms were severe suprapubic/pubic pain ( 26), gait difficulties ( 10) and intermittent fever ( 9). Diagnostic delay was between 1 and 12 months. The diagnostic imaging included magnetic resonance imaging (MRI) ( 24), computer tomography (CT) ( 17) and/or PET-CT ( 10), predominantly displaying bone destruction/erosion of the symphysis ( 13), abscess ( 12) and/or fistula ( 5) in the adjacent muscles. All patients underwent surgical debridement with resection of the symphysis and received a minimum of 6 weeks antibiotic treatment. Fourteen patients presented with monocultures and 4 patients with polycultures. Five patients underwent at least one revision surgery. Twenty-three patients experienced postoperative pain relief at 6 weeks follow-up, and 19 patients were ambulant without walking aids. Conclusion: SAS are rare conditions and should be suspected in patients with infection, pubic pain and impaired gait, especially after pelvic surgery. Bone infection, abscess and fistula near the symphysis can be visualized with proper imaging, most frequently with MRI. For most patients in this cohort surgical debridement combined with a minimum of 6 weeks antibiotic treatment resulted in pain relief, improved walking ability and a low recurrence rate.

An In Vivo Observational Histological Study of Peripheral Arterial Damage in Patients with Acute Limb Ischemia in SARS-CoV-2 Infection.

Thromboembolic events, such as acute limb ischemia, were reported worldwide in patients with COVID-19, suggesting that SARS-CoV-2 infection acts like a redoubtable prothrombotic factor in these patients. The aim of the study was to summarize the histopathological changes found in the arterial wall, intraarterial thrombus, and adjacent skeletal muscles. Considering the lack of evidence from in vivo studies, we performed observational histological research of peripheral arterial damage in patients with acute limb ischemia and SARS-CoV-2 infection. We investigated 22 patients with acute limb ischemia and SARS and harvested histopathological samples from those who agreed to this procedure. We performed histologic tissue harvesting during the revascularization procedure from the thrombosed area of the common femoral artery. Morphologic analysis was made on the hematoxylin-eosin (HE) stain. Special stains were also used—Elastica van Gieson (EvG) and Alcian Blue—Periodic Acid—Schiff (AB-PAS) and primary antibodies—CD45 and CD61. Our patients had significant risk factors for thrombus formation, since all of them had arterial hypertension, 81% had dyslipidemia, 73% were obese, 63% suffered from diabetes mellitus, and 45% were active smokers. The histological findings using immunohistochemistry (CD45 and CD68 reactions) or special and usual stains underlined the mechanism for ischemia production in SARS-CoV-2 patients. The main histological findings in our study were endothelial destruction and inflammation that were found in all analyzed structures.

A Retrospective and Anatomical Study Describing the Injection of Botulinum Neurotoxins in the Depressor Anguli Oris.

The depressor anguli oris acts to lower the lateral corners of the mouth and can cause an individual to appear sad or angry and contribute to the development of the labiomental folds. Many patients can benefit from the injection of small amounts of botulinum neurotoxin into the depressor anguli oris to enable the lip elevators to reposition the corners of the mouth. Although effective, the procedure is off-label, and the proximity of the depressor anguli oris to the depressor labii inferioris, particularly inferiorly, can lead to inadvertent treatment of the latter, resulting in lip asymmetry. The authors have taken a threefold approach to establish a depressor anguli oris injection technique that provides optimal aesthetic outcomes with a low incidence of adverse events. This involved, first, reviewing the limited existing literature for studies discussing depressor anguli oris anatomy and botulinum neurotoxin treatment technique; second, supplementing information from the published literature with information from cadaver dissections to demonstrate the relationship between the depressor anguli oris and surrounding anatomical structures; and third, performing a retrospective chart review of 275 patients treated with the authors' three-point injection technique. Combining data from published studies, cadaver dissections, and clinical experience, the authors demonstrate that a three-point technique performed in the upper half of the depressor anguli oris is associated with good clinical outcome and avoids common side effects related to injection or spread of neurotoxin to adjacent muscles. Therapeutic, IV.

Tips and Tricks for Facial Toxin Injections with Illustrated Anatomy.

After studying this article, the participant should be able to: 1. Recognize facial muscle contraction direction and muscle morphology based on skin surface movements and facial rhytides. 2. Classify different muscle contraction patterns and target respectively with the recommended dosage and injection technique. 3. Apply the presented injection techniques to the patients' individual anatomy with greater precision and without affecting adjacent muscles or causing other adverse events. Facial muscular anatomy has recently gained increased attention, with new investigative methodologies and new injection techniques arising on the market. These recent advancements have increased our understanding about the functional anatomy of facial muscles and have changed the way health care professionals see and understand their interplay during various facial expressions and in determining facial shape. This new anatomical understanding of facial muscles and their interaction has resulted in superior neuromodulator treatment outcomes with fewer side effects and with increased precision. The latter is of greatest importance, as all facial muscles act as a unit and connect with each other. It is therefore paramount to target during neuromodulator treatments only the muscle responsible for the aesthetic effect desired and not other adjacent muscles, which can have different or even antagonistic effects. Conventional anatomy was previously limited to two-dimensional explanations of muscle locations without incorporating their detailed action or their three-dimensional location of extent. The "new" anatomy incorporates those novel concepts and, once understood, will help health care providers to understand better and to "read" the underlying muscular anatomy based on the wrinkle status and based on the change in skin surface landmarks based on the actions of the underlying musculature. The following article summarizes tips and tricks, pearls and pitfalls, and dos and don'ts during facial neuromodulator injections along with a guide toward adverse event management and patient outcome assessment with special focus on the underlying anatomy.

Mosaic dysfunction of mitophagy in mitochondrial muscle disease

SummaryMitophagy is a quality control mechanism that eliminates damaged mitochondria, yet its significance in mammalian pathophysiology and aging has remained unclear. Here, we report that mitophagy contributes to mitochondrial dysfunction in skeletal muscle of aged mice and human patients. The early disease stage is characterized by muscle fibers with central nuclei, with enhanced mitophagy around these nuclei. However, progressive mitochondrial dysfunction halts mitophagy and disrupts lysosomal homeostasis. Interestingly, activated or halted mitophagy occur in a mosaic manner even in adjacent muscle fibers, indicating cell-autonomous regulation. Rapamycin restores mitochondrial turnover, indicating mTOR-dependence of mitochondrial recycling in advanced disease stage. Our evidence suggests that (1) mitophagy is a hallmark of age-related mitochondrial pathology in mammalian muscle, (2) mosaic halting of mitophagy is a mechanism explaining mosaic respiratory chain deficiency and accumulation of pathogenic mtDNA variants in adult-onset mitochondrial diseases and normal aging, and (3) augmenting mitophagy is a promising therapeutic approach for muscle mitochondrial dysfunction.

Helminth larvae of hygienic-sanitary importance parasitizing Fistularia petimba Lacepède, 1803, collected from fish markets of the municipality of Cabo Frio, RJ, Brazil

Fistularia petimba is a fish species that has gained growing interest due to its appreciation for sushi and sahimi in Japanese restaurants of the coastal cities of Cabo Frio and Armação de Búzios, state of Rio de Janeiro, Brazil. The constant presence of helminths in the viscera, serosa and adjacent musculature of this fish has been the subject of important complaints among local fish traders, because of economic losses due to their repugnant aspect. Considering their hygienic-sanitary importance and significance for collective health, the presence of helminth larvae was investigated in 32 individual fish of F. petimba purchased from fish markets in the municipality of Cabo Frio in 2019. Cestode larvae, identified as Tentacularia coryphaenae, were found parasitizing the abdominal cavity and mesentery. Nematode larvae, identified as Hysterothylacium fortalezae and H. deardorffoverstreetorum, were found parasitizing stomach, intestine, liver, spleen, liver serosa, mesentery and abdominal cavity. Hysterothylacium fortalezae had the highest parasitic indices, with a prevalence of 43.75%, mean intensity of 8.07, mean abundance of 3.53 and range of infection of 3-25 specimens per host. Considerations of the zoonotic potential and hygienic-sanitary significance of these helminths are presented to increase food safety for consumers.

Magnetic Resonance Imaging findings in Primary Extracutaneous Melanoma from a Tertiary Cancer Care Centre: A Retrospective Cohort Study

Introduction: Extracutaneous melanomas are rare, aggressive type of tumour, clinically and biologically distinct from their cutaneous counterpart. The two large broad categories of the extracutaneous melanomas are ocular and mucosal subtypes. Melanomas are classically hyperintense on T1 weighted images and hypointense on T2 weighted images due to the paramagnetic effects of melanin and presence of paramagnetic elements. Aim: To describe the Magnetic Resonance Imaging (MRI) findings in primary extracutaneous melanomas at various anatomic sites. Materials and Methods: This was a retrospective study in which 13 cases of primary extracutaneous melanomas were identified from Picture Archiving and Communication System (PACS) archive over a period of eight years (January 2013 - December 2020). Location and morphology of the tumour, signal intensity characteristics in T1 weighted, T2 weighted (hyperintense/ isointense/hypointense to adjacent muscle) and Diffusion Weighted Imaging (DWI) (presence or absence of diffusion restriction) were analysed. Results: The ocular melanomas (n=2) were seen as well-defined small intraocular mass attached to the choroid. The mucosal melanomas of the nasal cavity (n=2), rectum (n=4), vagina (n=3) and cervix (n=2) presented as large intraluminal polypoidal masses. Three categories of MRI appearances emerged in this study. Majority of the cases (n=8) showed hyperintense signals in T1- weighted images and hypointense signals in T2 weighted images (category 1). Diffusion restriction was seen in all cases (n=13) with low Apparent Diffusion Coefficient (ADC) values which ranged from 439-966 mm/sec with an average value of 755 mm/ sec. Conclusion: T1 and T2 shortening are typical of melanoma, the absence of these does not exclude the diagnosis. Although diffusion restriction and low ADC values help in the diagnosis of these tumours, they do not tend to play a specific role in the diagnosis.